Preparing for the California End of Life Option Act: How to Get Started If You Think You Might Qualify

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California’s End of Life Option Act is scheduled to begin June 9. It offers dying patients the option to obtain life-ending medication from a licensed, participating California physician.

Who can qualify and use the California End of Life Option Act?

The law requires that you first be a legal resident of California. In addition, you must have a terminal illness and be expected to die of it within 6 months, and you must be of sound mind and able to fulfill all the steps required by the law. You must also be capable of self-ingesting the medicine. That means you must be able to swallow about a half cup of medicine in about 2 minutes or less. People with end-stage neurologic diseases might have a problem with this last requirement.

People with bad pain but no terminal diagnosis, people with Alzheimer’s disease, or people who are not mentally competent (because of psychiatric disease, mental disability, or those who are found to be legally incompetent by court hearing) cannot qualify to use the law.

Oregon and Washington have information about the patients who have used the law in their states, on their respective Department of Health websites.

How near death do I have to be to start the process under the End of Life Option Act?

You need to be within 6 months of death, as agreed upon by two independent, licensed physicians. If you think you might be interested in using life-ending medication, it is better to start working on this sooner than later. In Washington and Oregon, the average time it takes for a patient to qualify for the law and get the prescriptions written, is between 45 and 50 days.

Even if you qualify and have prescriptions written, you never have to use the medicine. After the prescriptions are written, you have the choice available to you to use the medicine any time or to not use it ever.

Are there people who do not qualify to use the law?

Yes, people who have a great deal of pain but no life-threatening illness or those with a mentally or (in some cases) physically disabling disease, or people who may be elderly and have numerous diseases but no life-threatening illness, will not qualify for using the law. The law requires that the patient has a 6-month terminal diagnosis, is of sound mind, and is able to self-ingest the medication.

Do I have to wait until June 9 to get started?

No. You can start talking to your doctors right away.

First of all, you need to find out if you are expected to live more than 6 months without treatment. If the answer is yes, you will not qualify for the law at this time. If the answer is no, because your doctors expect you to die within 6 months, then you need to ask your doctor if he or she is willing to participate in the End of Life Option Act. If the first doc says yes, you can now ask another of your (probably many) doctors if he/she will participate. You need two licensed doctors to certify that you are within 6 months of death. One of those physicians will need to be willing to learn about the details of the law, and walk you through all the tasks required in the law. Make sure one of the two doctors who agree to help you is willing to do this. That doctor will be your attending physician for the law, and is the person who will be writing the life-ending medication prescription for you. The second certifying doctor will be the consulting physician under the law who simply has to certify that you are within 6 months of death.

Though the doctors helping you cannot start the process required by law until June 9, it might take that long to find two doctors who are willing to provide the service for you. Not many doctors know about the law yet, or what is required. The law says every physician has the choice not to participate. So start talking about it. Any licensed California physician is allowed to participate if he or she agrees. Ask the doctors who are providing care for you, be it your oncologist, or hospice physician, or neurologist.

While you may be receiving care from a nurse practitioner or a physician’s assistant, these healthcare professionals are not allowed to act as licensed physicians for the End of Life Options law.

What happens if I cannot find two doctors to participate?

Keep asking.

There is one doctor in the San Francisco Bay area who is in the process of starting up a practice dedicated to helping patients at end of life who cannot find another doctor to write the prescriptions. He, or other motivated doctors, may agree to be your attending physician under the law if you cannot find two of your own doctors to help you.

Is there a patient help line in California?

If you run into a brick wall, there will be a help line that will answer questions for California residents, provided SB 1002, currently pending in the California Senate, passes. The bill would establish a toll-free telephone line, staffed by the California Department of Public Health, providing information about the End of Life Option Act. Until then, call the Death with Dignity National Center at 503.228.4415.

Does this mean I can skip signing up for hospice?

No! Look into joining hospice, right away. If your doctor has told you that you have a 6-month terminal diagnosis, you should qualify for hospice support immediately. You don’t need to make use of any hospice services soon, it just helps to be approved so you can get support quickly when you need it. Ask your regular physician for a hospice referral, and get that started if you can.

Hospice not only offers lots of support for you as your disease progresses, e.g. a home hospital bed, home oxygen, meds, nursing care, or spiritual support, but also has many services available to support your family members.

If you later qualify for the End of Life Option Act but decide not to use the life-ending medication that is prescribed, hospice will be able to offer you comfort care and increased pain medication, if you need them.

Can the law be used with Advance Directives?

Advance Directives are legal documents that describe what a dying person wants done (or not done) medically if he/she can no longer communicate. The California End of Life Option Act cannot be used under Advance Directives, as the person is no longer of sound mind when the advance directives kick in.

What does the law say that I have to do?

The California law requires you to find two doctors who agree that you have 6 months or less to live, without further treatment of disease. As soon as you think you want to start the process, and any doctor has given you that 6 month terminal prognosis, ask the doctor to document your request in your medical chart, starting June 9. This is very important, as it becomes your first oral request to use the law. Even a doctor who does not want to participate under the law can document this first verbal request and it will count as the starting date in your qualification. Remember, you cannot make your first request until June 9, 2016, as that is the date the law will be implemented in California.

You need to make a second verbal request to your attending physician at least 15 days after your first documented physician request.

You also need to sign a written request for medication, which documents that you know what disease you have, that you have less than 6 months to live, and that you have been informed of alternative choices available to you. However, you cannot sign this paper until after you have been seen by both of your participating physicians.

Is the medicine a magic pill?

No. The medicine is a very large dose of a sleeping medication, most commonly a barbiturate, in powder form. It is mixed with liquid before you, the person for whom it is prescribed, drink it, and it has a rather bitter taste. The full amount needs to be ingested in a minute or two. I often suggest that my patients have a small glass of a delicious tasting liquid nearby, to cleanse their palates, after drinking the entire amount of life-ending medication.

Most patients fall asleep peacefully about 10 minutes after drinking the life ending medication, and die in 1-3 hours. In about 5 percent of patients, it takes longer than 6 hours to die, but they sleep comfortably the whole time, until death ensues.

Does the medicine always work?

Oregon, Washington, and Vermont have very similar laws, and in the last 18 years, over 2,000 patients have legally received life-ending medications in these states. During that time, there have been fewer than 5 patients who have taken the medication and who have not died. They may have ingested only a portion of the medication before they fell asleep, or they may have mixed the medications too far in advance and let it sit on a shelf, which caused a decrease in potency or crystallization. In one case more than 15 years ago, an inadequate dose for the patient’s weight was probably prescribed.

What other options do I have available if I don’t want to use the life ending medication?

Hospice works with you to provide support and pain relief, as you near the end of life.

Palliative sedation is sometimes available. This provides IV pain and sedative medication if you are a hospice patient who is suffering with unendurable pain. Not all places have palliative sedation available for dying patients, as it necessitates IV infusion drugs to the point of sleep and unconsciousness.

Should I tell my family?

Every family is different, and many families have had strained relations. However, even if there has been little communication for years, the months or weeks before death is a time when many people attempt to open up to each other. It is amazing how many families come around to reestablish communication, and offer support, as they learn what their relative is struggling with.

It is truly in the best interest of those who will be left behind that you tell your family what you are planning, and give them the option to accept or reject it, or to work out personal past differences. This helps those family members cope better after you die, as they have some good, positive memories.

Even if your family cannot support you or what you are choosing to do, by starting the dialogue you have at least given them the chance to understand and grow. And most families rise to the occasion of help, support, and understanding.

Is this suicide?

This law makes it very clear that a terminal patient, who fulfills all requirements set forth in the law, and ingests the life-ending medication is not committing suicide. It is your disease that is killing you. The medication simply allows for a calm, peaceful end to what otherwise could be a death full of indignity, pain, and suffering.

Suicide occurs when a person who has no terminal illness is successful in ending his or her own life voluntarily, or when a sick patient is not under the protection of the End of Life Option Act and takes his own life.

Will my death certificate say I committed suicide?

No. For any patient who uses the life-ending medication option under the California law, the cause of death, as documented on the death certificate, will be the disease that is going to cause the patient to die within the next 6 months.

Can I just fly to California, get qualified, and fly home with the medication?

No. You must be a California resident, and be planning to die in California, to qualify under the law.

Does everyone take the prescribed medications?

No. About one third of qualified terminally ill people decide that they do not want to hasten their death using the prescription. The prescription provides them with peace of mind, knowing if their symptoms get too bad, they can choose to take the medication. Nothing in California’s End of Life Option Act tells a patient that he/she must take the medication after going through all the steps to qualify.

Should I wait until I am close to death before I get started with the End of Life Option Act process?

No. Looking into this sooner is much better than later! Many people do not actually seek out this option until they have tried absolutely every drug, chemo, or treatment regimen available for their disease, and are near death. Under the law, the very fastest it is possible to qualify a patient and obtain the drugs is about 3 weeks, and the average is 45-50 days. If you are close to death before starting to find doctors and make your first verbal request, you may not live long enough to be able to obtain the medication you seek.

After your prescription is written, you never have to use it. You can leave it at the pharmacy indefinitely, until you decide that you want to make this choice, at the time that is right for you. It is your choice to decide if you ever want to fill and use your prescription. This law is all about giving you this choice as a resident of California.

Will my life insurance still pay out if I take the life-ending medication?

As long as you go through all the steps required by the law to obtain the medication, your life insurance benefits should be unaffected. The cause of your death on your death certificate, for the documentation by the life insurance company, will be listed as the disease that your doctors expect will cause your death in the next weeks or months.

How much will the life-ending medication cost?

The cost depends upon the state plan. In Oregon, the cost of using the medicine is covered by State Medicaid reimbursement. In Washington, the individual patient is responsible for covering the cost of the medicine themselves. In California, a portion of the cost will likely be covered by Medi-Cal.

How will I know when it is the right time to take the life-ending medication?

You are the only person who can decide if and when you want to take the prescribed medication. This is a decision that is often made by conferring with your family, as they are also aware of the changes happening to you as your disease progresses.

As a guideline, I suggest to my patients that a good time to take the medication is when the quality of life has decreased to an unacceptable or intolerable level, and all that is left for them are days of suffering. The suffering can occur on many levels: pain with every movement, the indignity of having someone you love change your diapers and position your body for you, feeling like a financial, physical, or emotional burden, or the recognition that you are becoming so weak that you might not be able to swallow 4 ounces of liquid for long. It can also include the fear of total loss of control of your life.

Your family will probably be happy to watch with you, monitor your decreasing ability to function, and help you make the decision about when to take the prescribed medication, as your time gets shorter. I believe you will know when the time is right. If the time is never right, that is fine too. A significant number of patients qualify for the life-ending medication but never ingest it.

Are there any reasons I will not be able to take the medication after it has been prescribed and is available to me?

There are basically 3 things that can keep you from taking the medication, after it has been prescribed:

If your disease progresses to coma or death, you obviously can no longer ingest the medication.

Tumors in your brain, or certain metabolic problems, can affect brain function. If you are experiencing severe and increased confusion, and you have lost the capacity to understand and make decisions, you will no longer qualify to take the medication. On the day you take the prescribed medication, you need to be able to ask for it, and be cognizant of what it is for.

The last thing which can prevent you from successfully ingesting the medication is the inability to swallow the 4 ounces of liquid within 2 minutes or less. This might occur with progressive overwhelming weakness from end stage illness, or from a neurologic disease like ALS.

Why do I have to wait until June 9, 2016?

The California legislators passed the End of Life Option Act in 2015. It takes a lot of work to get everything ready for implementation after a law is passed. California set the target date for implementation as June 9. As implementation of the law begins, it may be slow working through this procedure for the first patients, as everything is new.

Even though you cannot make your first request until that date, you can start now by talking to your family and your doctors. If you can find two doctors willing to participate before June 9, you will have cleared a major hurdle, and the process can begin soon thereafter.

While you are waiting, don’t forget to live your life and look for a little bit of joy in every day. Dying is not for the faint of heart. Your disease has taken away your control over life in almost every aspect: eating, sleeping, pain, loss of ability, money, dignity, you name it. This can be a very discouraging time.

If the California End of Life Option Act seems to offer you a little control over your death, and you think you might want that choice, then it is your legal right. You can begin the process, as soon as the law goes into effect.

However, during the days, weeks, months you need to wait before you can accomplish this, remember that you do have some control left. You do have the ability to find some joy, or beauty, or a moment without pain, in every day. You do have the ability to thank those who are helping you through this time. You do have the time to say all the things that other people in your life need to hear before you die. You might even have time for a couple of the items on your bucket-list.

Use this time well. People in car-crash deaths never get to tie up the loose ends or say final goodbyes. Every day has at least one precious moment. I hope you find many.

About the Author

Dr. Carol Parrot is an anesthesiologist who has practiced in western Washington state for 32 years, both in private practice and the university setting. In addition, she participated in numerous medical missions to Third World countries, for cleft lip and palate repair. Since her retirement in 2012, she has remained licensed, and her practice is devoted solely to Death with Dignity patients throughout Washington state, serving as an attending or consulting physician. She has lectured on Death with Dignity nationally, and given testimony before legislators considering the bill.

Dr. Parrot has compiled this Q&A based on the questions she hears her patients ask about the Washington Death with Dignity Act to help California residents with preparing for the End of Life Option Act, which takes effect on June 9, 2016.

While have verified the facts in this article, the text itself reflects the author’s views only; we neither endorse or disapprove of its content but rather publish it to foster the conversation about end-of-life issues.

42 Comments.

Will

Julia Hanway

May 11, 2016 at 4:21 am

Early on-set Alzheimer’s patients should contact Final Exit Network (www.finalexitnetwork.org) for options available to hasten one’s death in a peaceful and compassionate manner with support and education through its exit guide program. Sadly, those suffering from Alzheimer’s are not helped by this law.

jude asphar

June 2, 2016 at 1:07 pm

Bearing in mind Alzheimers is defined as an incurable, fatal disease, it is morally reprehensible — and frankly cruel — that those of us who want to opt out while we are still able to do so for ourselves, will be tagged as suicide.

Debra

November 26, 2017 at 8:15 pm

How very very sad. No matter what sickness you have it should be your right-to-die the way that you want to die.
You should be able to have some type of serenity.
And not put your children through any more pain than necessary.

Mari Lisicki

May 10, 2016 at 5:34 pm

Thank you so much for this information, it truly gives me hope that I don’t have to suffer forever. Life is too precious to consider suicide, it doesn’t take the pain away it dumps it on someone else but suffering is something that changes your life and if you have no quality of life, this is wonderful.

Norma

Jaye Walton

June 3, 2016 at 6:04 am

It’s not fair. I am in so much pain. Hep C since my 20’s but no one ever told me. Sick since 2001. Only officially diagnosed since 2008. During these years all of my body systems are shutting down (diagnoses and symptoms too long to list) but I may linger with increased discomfort for years. Things are really bad now, but cannot get adequate pain relief since my doctors are afraid for legitimate reasons. If I was an animal I would be given mercy and “put down”. Since I am a human and most humans are afraid of death I am doomed to existing in a life with no quality to it. I do not have the money to relocate and seek residency elsewhere. I am in New York, just not fair. Anyone want to ban with me in taking NYS to court for the right to die with dignity.

Death with Dignity

June 8, 2016 at 1:22 pm

Norma, the NY State Assembly Health Committee passed the Medical Aid in Dying Act on May 23. There will likely be no further activity before the summer recess. We’ll keep you posted on the next steps after that.

Jaye Walton

June 3, 2016 at 6:02 am

It’s not fair. I am in so much pain. Hep C since my 20’s but no one ever told me. Sick since 2001. Only officially diagnosed since 2008. During these years all of my body systems are shutting down (diagnoses and symptoms too long to list) but I may linger with increased discomfort for years. Things are really bad now, but cannot get adequate pain relief since my doctors are afraid for legitimate reasons. If I was an animal I would be given mercy and “put down”. Since I am a human and most humans are afraid of death I am doomed to existing in a life with no quality to it. I do not have the money to relocate and seek residency elsewhere. I am in New York, just not fair.

Death with Dignity

Faye Girsh

June 4, 2016 at 10:37 pm

If you are not eligible for the CA law you can contact Final Exit Network (866-654-9156) to join and receive information and support about other methods for hastening death if you qualify for their services (see http://www.finalexitnetwork.org) They operate anywhere in the continental United States.

fatma

Death with Dignity

Thomas Redner

June 6, 2016 at 7:36 am

I am a physician former anaesthesiologist.
Definitely want to be involved in the change of paradigm.
I have donated several times..
Thank you for your work.
I am in Massachusetts.Not sure where the movement on DwD is here.

Jennifer

June 7, 2016 at 6:24 pm

This article contains several inaccuracies:

The statutory definition of terminal disease in the CA End-of-Life Option Act makes no mention of whether treatment is being administered or not: “ ‘Terminal disease’ means an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgement, result in death within six months.”

The doctor who will assist the patient in fulfilling the requirements of the law and who will prescribe the medications can’t just be the “attending physician for the law” — he/she must be “the physician who has primary responsibility for the health care of an individual and treatment of the individual’s terminal disease.” The second “consulting physician” must be independent from the first doctor and must not only certify the terminal illness and 6-month’s prognosis, but must also confirm the patient’s mental capacity (absence of any mental condition that might impair judgement), informed consent, and that the patient is acting voluntarily. If either the attending or consulting physician suspects mental illness, the patient must be referred to a consulting psychiatrist/psychologist for an evaluation.

This statement is also incorrect: “Any licensed California physician is allowed to participate if he or she agrees.” The law allows facilities and healthcare provider entities to forbid participation in the law on premises or within the scope of employment or contract. Some physicians, even though they “agree,” may not be allowed to participate by the facility in which the patient resides or receives care or by the entity which employs or contracts with the physician.

This summary makes no mention of the “final attestation” that persons intending to ingest the lethal medications must sign within 48 hours prior to ingestion.

This statement is also incorrect: “Advance Directives are legal documents that describe what a dying person wants done (or not done) medically if he/she can no longer communicate.” Advance Directives are documents that describe what ANY PERSON WITH SERIOUS ILLNESS OR INJURY wants done (or not done) medically if he/she IS NO LONGER CAPABLE OF MAKING OR COMMUNICATING MEDICAL DECISIONS.

In order for Medi-Cal to cover the cost of the prescription, the patient must be a Medi-Cal (Medicaid) beneficiary. Medicare will not cover the medication and private insurers will have differing policies.

George Eighmey, President, Death with Dignity National Center

June 10, 2016 at 9:02 am

Dear Jennifer,

Thank you for your comments. I prepared responses to your concerns below. I hope they address your concerns.

Your comment: The statutory definition of terminal disease in the CA End-of-Life Option Act makes no mention of whether treatment is being administered or not: “‘Terminal disease’ means an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgement, result in death within six months.”

Our response: Jennifer, the Act specifically states that the “Attending physician” means the physician who has primary responsibility for the health care of an individual and treatment of the individual’s terminal disease. (Emphasis added). By definition the attending physician is treating the patient for his/her underlying illness.

Your comment: The doctor who will assist the patient in fulfilling the requirements of the law and who will prescribe the medications can’t just be the “attending physician for the law” — he/she must be “the physician who has primary responsibility for the health care of an individual and treatment of the individual’s terminal disease.” The second “consulting physician” must be independent from the first doctor and must not only certify the terminal illness and 6-month’s prognosis, but must also confirm the patient’s mental capacity (absence of any mental condition that might impair judgement), informed consent, and that the patient is acting voluntarily. If either the attending or consulting physician suspects mental illness, the patient must be referred to a consulting psychiatrist/psychologist for an evaluation.

Our response: That the prescribing doctor is the attending physician under the law is factually accurate. That there are further requirements for this doctor, while true, is outside the scope of the referenced statement. We have updated the requirement for the consulting physician.

Your comment: This statement is also incorrect: “Any licensed California physician is allowed to participate if he or she agrees.” The law allows facilities and healthcare provider entities to forbid participation in the law on premises or within the scope of employment or contract. Some physicians, even though they “agree,” may not be allowed to participate by the facility in which the patient resides or receives care or by the entity which employs or contracts with the physician.

Our response: A qualified physician may participate voluntarily and any physician may also opt out voluntarily. The same goes for their employers. If a physician wishes to participate but their employer has opted out does not negate that physician’s agreement to participate or their ability to do so with a participating employer. The physician may participate off-duty and off-premises of the prohibiting facility without fear of sanctions.

Your comment: This summary makes no mention of the “final attestation” that persons intending to ingest the lethal medications must sign within 48 hours prior to ingestion.

Our response: The Death with Dignity Laws in Oregon, Washington and Vermont do not require a “final attestation” provision. However, it is required in the California law and must be followed.

Your comment: This statement is also incorrect: “Advance Directives are legal documents that describe what a dying person wants done (or not done) medically if he/she can no longer communicate.” Advance Directives are documents that describe what ANY PERSON WITH SERIOUS ILLNESS OR INJURY wants done (or not done) medically if he/she IS NO LONGER CAPABLE OF MAKING OR COMMUNICATING MEDICAL DECISIONS.

Our response: We do not see anything inaccurate with the statement. A dying person certainly falls under the “any person” category and if they can no longer communicate they can certainly no longer communicate medical decisions as well.

Your comment: In order for Medi-Cal to cover the cost of the prescription, the patient must be a Medi-Cal (Medicaid) beneficiary. Medicare will not cover the medication and private insurers will have differing policies.

Our response: We agree the patient must be covered by Medicare to be under Medi-Cal, but the payment for the medication is made from California funds, not the federal funds, therefore, it does not violate the Medicare prohibition on paying for the medication.

Alisa Dodge

June 15, 2016 at 9:34 am

George – are you with Death with Dignity? My Dad has terminal throat cancer and really wants to use this new Act. He only has Medicare. So I just want to make sure that your response that Medicare WILL pay for this is accurate; that you have some sort of “inside” knowledge to make this statement. And, if you do have inside knowledge – do you know where I can call at Medicare to find out if they have ID’ed any doctors who are willing to assist with this Act.

Death with Dignity

June 15, 2016 at 9:42 am

George Eighmey is our organization’s president, Alisa. Since your comment, I’ve updated his entry to reflect the affiliation.

Nowhere in his comment does George state that Medicare will pay for medications under the End of Life Option Act. Federal funds cannot be used for this purpose. Rather, it is Medi-Cal, California’s Medicaid program, that will cover a portion of the cost.

Alisa Dodge

June 15, 2016 at 9:54 am

Thank you for the quick response. I took the comment ” it does not violate the Medicare prohibition on paying for the medication.” wrong. It sounds like if my Dad only has Medicare, he will have to pay for it himself – unless he can sign up for Medi-Cal. He does live with me in California. Can he sign up for Medi-Cal? I am completely ignorant of how this insurance works.

Also, since he is not associated with a health provider who has opted in on the Act, does Death with Dignity know of any doctors who have said they will assist with the Act?

Thanks again!
Alisa

Death with Dignity

June 15, 2016 at 10:07 am

We do not have insight as to Medi-Cal procedures outside what we read at websites like this one:

There are no lists of doctors willing to prescribe under the End of Life Option Act. The same is the case in OR, VT, and WA.

Evelyn kern

June 11, 2016 at 11:31 am

As a California resident, after reading the above, I feel discouraged,. I have neuropathy for the last 7+ years, have undertaken the medical advice of several doctors to no avail. my PCP has given me gabapentin, Zoloft and Prozac. Only the last two meds removed the stabbing pain but not the all-body constant feeling of lying on a bed of coals. Side effects of Zoloft and Prozac forced me to quit them . I am 91 years old, am regularly attacked every 1 to 2 hours nite and day with sharp stabbing pain all over my body. I can’t sleep more than an hour at a time. And yet it seems I don’t qualify under Calif law for end of life relief. It seems. Physicians care less about suffering and pain than they do about tending to patients becoming vegetables using up State and Federal funds.

Martin Seidenfeld

August 9, 2016 at 8:27 am

Evelyn, your situation sounds truly awful. Even if California law is such that you do not qualify under its Death with Dignity act it may still be possible for you to end your life with dignity at a time of your own choosing. Final Exit Network offers information and education about how to achieve a peaceful death. For additional information, see finalexitnetwork.org.

Allison

July 28, 2016 at 11:34 am

My dad was diagnosed with stage 4 gastric cancer the day before we watched my mom pass away from brain cancer in April. The doctors gave him 4 to 6 months. He is now on hospice but doesn’t want to go through what he saw my mom go through. He’s asked me to help him find physicians that would help him with assisted suicide. However, I have to found anyone in our area( Palmdale/Lancaster, CA) who is willing to partake. Is there some sort of list or anything that might help us find someone who will help???

Allison

Death with Dignity

July 28, 2016 at 11:50 am

There is no list of physicians who are willing to participate in the California End of Life Option Act (the same is the case in OR, VT, and WA for their respective Death with Dignity laws). However, certain providers in some locations allow their doctors to participate. Note that individual doctors have the right to refuse to participate.

Carmelita Liwanag

August 26, 2016 at 5:17 pm

Hi! Trying to implement this End of Life Option Act with our small hospice. Do you have a list of participating pharmacies? Our contracted pharmacy is just starting to look into it. Would like to have a pharmacy that I can include in the policy. Thank you for what you do!

Death with Dignity

August 30, 2016 at 11:41 am

There is no list of pharmacies dispensing medications under the Act. We would suggest you call around or search for “compounding pharmacies california” to find the right place (medications prescribed under the Act are either Seconal or a compound that a compounding pharmacy must prepare).

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Diana

August 6, 2017 at 7:15 am

I found out in 2015 that I had multiple myeloma after having 4 back surgeries in 2 months. It turns out that the doctor in another state where I used to live documented my cancer in 2010 but never told me!! At this point they cannot do a bone biopsy because it would break a bone because my cancer eats holes in my bones so how am I supposed to get a diagnosis of six months or less to live? I have went through enough pain I do not want any more pain if they insist on a bone biopsy I have a left knee that is going out and a right hip.

Florence

Peter Korchnak, Death with Dignity

September 18, 2017 at 9:24 am

We do our best to update the content at our website with the latest available information. Given the size of the site and amount of content, this isn’t always possible and, when it comes to blog posts, which are published on certain dates, not entirely practical. Just as the “Preparing…” article was current and topical at the time of publication, we published an update on the first California annual report at the time it was current:

Florence

Peter Korchnak, Death with Dignity

September 18, 2017 at 9:25 am

There are no physician lists in any of the states with death with dignity laws. To our knowledge, no one, including our organization, compiles these. However, we do have a small running list, gathered from publicly available sources, of healthcare providers (hospitals, HMOs) that allow their doctors to participate. Please email us at info@deathwithdignity.org.

Amanda Birchfield

Melissa

August 27, 2018 at 12:07 pm

I have been a type 1 diabetic for 37 years. I have stage 3 kidney disease and now gastroparesis. I am unable to eat or keep down food with any consistency. I am basically starving to death slowly. I do not want a feeding tube. Does this qualify as a terminal illness? Also, are there any groups that will act as witnesses if none of your family will participate?

Peter Korchnak, Death with Dignity

Death with dignity laws do not specify what illness qualifies, only that it be terminal with a <6-month prognosis.

We are unable to confirm whether you would qualify. That determination is up to two physicians licensed to practice medicine in the state where you wish to use the law.

We are not aware of any groups that would provide witnesses for the written request. You can ask your friends or other individuals to witness your signature, provided they meet the legal requirements outlined in the law.

Afterword: Physician-Assisted Death Concepts

California’s Act for End of Life Options Passes Six-Month Milestone

Californians with terminal illnesses now have the option to work with their physicians to choose aid in dying, and while statistics on the use of the California End of Life Option Act have yet to be released, news reports have profiled several terminally ill patients who have used the law. By design, the process contains multiple steps and opportunities for patients to change their minds before being given access to prescription medications that will hasten their deaths. The safeguards in the law include getting both the attending physician and a consulting physician to verify the terminal diagnosis, 6-month prognosis and mental capacity. Patients also have to complete a final attestation within 48 hours of ingesting the medication to confirm they are making an informed, voluntary choice.